short case 1601006039

 SHORT CASE :

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👉 elevated JVP

A 45 yr old male patient who is a farmer by occupation resident of narketpally came to the OPD with chief complaint of 

Shortness of breath since 1 year and

Pedal edema since 3 months

History of present illness

He was apparently asymptomatic 1 year back then he developed shortness of breath which was insidious onset and gradually progressive from grade 2 to grade 4 it aggravates on lying down and on exertion and relieved on medication.

He also complaints of pedal edema which is insidious onset and gradually progressive starting from ankle to whole of lower limbs.

The patient also complains of decreased urine output since 1 month it is insidious in onset and gradually progressive

General examination

The patient is conscious coherent and cooperative Moderately built and Nourished

Pallor is present

There are no signs of icterus , cyanosis , clubbing koilonychia and lymphadenopathy

Bilateral pedal edema is present which is of pitting type.

Raised JVP present

Vitals

Afebrile

BP - 130/80mmHg

PR - 82 bpm , regular , normal volume

RR - 24 cpm

Local examination of Cardiovascular system

Inspection

- Trachea appears to be central

- Shape of the chest is normal

- Apical impulse appears to be shifted from normal position

- No visible scars , sinuses 

Palpation

- Trachea is central 

- Apical impulse is shifted about 4-5cm lateral to midclavicular line in the 6th intercostal space.

chest X RAY : 

    Cardiomegaly is seen

ECG : SINUS TACHYCARDIA. 

provisional diagnosis:

Elevated JVP due to HEART FAILURE  DUE TO FLUID OVERLOAD OWING TO CKD .

 

1601006039 LONG CASE

LONG CASE  :    

   This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent.

Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs.

This E log also reflects my patient centres online learning portfolio and valuable inputs on the comment box is welcome."                                                                     

  A 55 year old Male Farmer by occupation came with complaints of 
1)     Severe pain abdomen since 10 days
2)    Fever since 7days

Chief complaints: 

                            A 55 year old Male ,Farmer by occupation, resident of Miryalguda ,

 came with complaints of :

1) pain abdomen since 10day 

2) Fever since 7 days 

HISTORY OF PRESENTING ILLNESS:

                      Patient was apparently asymptomatic 10 days ago then he  developed 
👉severe pain abdomen in the right upper quadrant  of abdomen ,
➤which was sudden in onset , gradually progressive , dragging type and non radiating pain.
➤It is aggravated on standing position and relieved for sometime upon taking medication.
➤Not associated with nausea, vomiting, loose stools.
 👉then he developed  high grade  fever ,which was continuous  for 1 week and associated with chills and rigor. 

➤It is not associated with Cold,cough, shortness of breath,neck pain,giddiness, headache and sweating.

➤It is relieved on taking medications

-➤No complaints of chestpain, palpitations and burning micturition.

HISTORY OF PAST ILLNESS:

                       Patient was admitted in the hospital for 3 days with similar complaints ,14 days ago and was given IV antibiotics for 3days.
 There is no history of DM/HTN/EPILEPSY/ASTHMA/CVA/CAD.

Treatment history:

A  3 day high dose  antibiotics medication  14days ago
PERSONAL HISTORY:
                       Appetite -decreased since 1 week
                        Bowel and bladder-Regular
                        Micturition-normal
              Addictions- 
toddyconsumption- 1litre/day since 30years
Tobacco in the form of beedi- 10/day since 30years

FAMILY HISTORY: 

There is no relevant family history

General physical examination:

The patient is conscious, coherent and cooperative.
- He is well oriented to time, place and person.
- He is moderately built and moderately nourished.
Vitals:
- Temperature = he is now afebrile




 Pulse = 76 beats per minute, regular, normal in volume and character. There is no radio-radial or radio-femoral delay.
- Blood pressure = 110/80 mm of Hg
- Respiratory rate = 16 cycles per minute.
- JVP is normal
- icterus is seen on sclera
- There is pedal edema  which is Pitting type 
     •progressive in nature 
    • extent up to ankles

There is no  signs of Pallor, Clubbing, Cyanosis, Generalized lymphadenopathy 
Spo2 -96% on room air 
RR- 16 cpm
CVS -S1S2 heard no murmers 
RS-decreased air entry in right infraaxillary and infrascapular region  and bilateral fine crepitations are present in right lower lobe.

Abdomen examination:

INSPECTION
1)SHAPE of the abdomen:  symmetrical

          


PALPATION
2) tenderness in the right upper quadrant of abdomen noticed
 percussion
3)There is no palpable mass and liver span is 11cm.
4) hernial orifices are normal and umbilicus normal
5) There's no free fluid level
6)No bruits heard
7)Liver not palpable
8)spleen not palpable
AUSCULTATION
9)bowel sounds heard on auscultation.

  INVESTIGATIONS              

CBP :      low hbg, normocytic normochromic anemia

               low lymphocyte count 

LFT:  

elevated serum total bilirubin, direct bilirubin, low albumin levels.

CULTURE reports:

 Methicillin sensitive staphylococcus aureus

Plain radiograph of thorax showing right lower pleural effusion

USG : 

     Hetro echoic collections in  right lobe of liver are seen. 

APTT : normal

 PROVISIONAL DIAGNOSIS OF THIS CASE :

 based on the investigations:   liver abscess.

treatment recieved :